404628_Well Construction - GW1_20120423

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3094-A
1. WELL CONTRACTOR:
Ronald E Stewart
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach
City or Town
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#Of applicable)
SITE WELL ID #(if applicable) MW-C3
3. WELL USE (Check One Box) Monitoring Municipal/Public 0
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/13/2012
4. WELL LOCATION:
Proposed Wilminaton River Front Marina
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Han
NC 28428
State Zip Code
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley ❑ Flat Ridge ❑ Other
K(c I$TCD 34 iAAAA&AAAAAAAA! CL R OR 34'24579748 CC
KN'MF 1STCD 77 iAAAA&AAAAAAAA! CL R OR 7 951'20458 CC
Latitude/longitude source: 3PS :Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
River Front Marina
Facility Name
Nutt St.
Facility ID# (if applicable)
Street Address
Wilmington NC 28401
City or Town State Zip Code
Adam Lisk
Contact Name
720 North Third Street Sty 202
Mailing Address
Wilminaton NC 28401
City or Town State Zip Code
( 910n 251-6160
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 44"
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 51
c. WATER LEVEL Below Top of Casing: 3.25 FT.
(Use "+" if Above Top of Casing)
',#)
d. TOP OF CASING IS 0.5 FT. Above Land Surface`
*Top of casing terminated at/or below land surface may require
• a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NA METHOD OF TEST NA
f. DISINFECTION: Type NA Amount NA
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
Thickness/
7. CASING: Depth Diameter Weight Material
Top +0.5 Bottom -0.5 Ft. 2" S 40 PVC
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
i Top 0 Bottom -0.25 Ft.
: Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
: Top -0.5 Bottom -3.75 Ft. in. in.
- Top Bottom Ft. in. in.
Top Bottom Ft. in. in. r _
• p
\-\ \--q r
in 1 I
'N�aterial '
Size �� �
Material Method
: 10. SAND/GRAVEL PACK:
. Depth
Top -0.25 Bottom -3.75 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / -4
•
/
/
•
•
/
/
12. REMARKS:
APR 2 3 zoz
Formation Description
Disturbed Sediment and Debris
;Jac*
AtiK
1 ntor tnottOn
;WOG .
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD HAS BE PROVIDED TO THE WELL OWNER.
Bottom
Bottom
Bottom
3/26/201
a �w
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
/net
: Ronald E Stewart
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
`ubmit within 30 days of completion to: Division of Water Quail
17. Mail Service Center, Raleigh, NC 27699-161, Phone [phone]
Form GW-1 b
Rev. 1/08